From the Guidelines
Shoulder subluxation rehabilitation after stroke should prioritize proper positioning and support of the affected arm, using slings, lap trays, or arm supports, as well as education for patients and caregivers on proper arm handling techniques, as recommended by the most recent guidelines 1. The goal of rehabilitation is to address the mechanical instability caused by weakened shoulder muscles, which can lead to the humeral head dropping from the glenoid fossa, and to restore function while preventing complications like frozen shoulder or chronic pain syndrome. Key components of rehabilitation include:
- Proper positioning and support of the affected arm to prevent further injury
- Education for patients and caregivers on proper arm handling techniques
- Passive range of motion exercises in the early stages, gradually progressing to active-assisted and active exercises as muscle strength improves
- Specific exercises such as shoulder shrugs, scapular retraction, and gentle external rotation movements
- Consideration of electrical stimulation therapy, particularly neuromuscular electrical stimulation (NMES), to reduce subluxation and improve function, as supported by earlier studies 1
- Pain management, which may include acetaminophen or NSAIDs, if not contraindicated
- Strengthening exercises targeting the rotator cuff and deltoid muscles as recovery progresses It is essential to note that the use of supportive devices and slings for shoulder subluxation is considered reasonable, according to the American Heart Association/American Stroke Association guidelines 1. Additionally, healthcare staff, patients, and family should be educated to correctly protect, position, and handle the involved arm, as emphasized in the most recent systematic review and synthesis of global stroke guidelines 1.
From the Research
Rehabilitation Methods for Shoulder Subluxation
- Functional electrical stimulation (FES) is effective in reducing subluxation in the acute stage of stroke rehabilitation 2
- Orthosis or shoulder support can temporarily reduce subluxation while in situ 2
- Inelastic taping can reduce shoulder subluxation and pain in acute stroke patients 3
- Gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain 4
Risk Factors for Shoulder Subluxation
- Hemorrhagic type of stroke is significantly associated with shoulder subluxation 5
- Loss of proprioceptive sensation is significantly associated with shoulder subluxation 5
- Brunnstrom's stage of arm recovery is negatively associated with shoulder subluxation 5
Assessment and Management
- X-ray is the most commonly used assessment tool for subluxation 2
- Ultrasonography may be a more precise and valid tool for assessing subluxation 2
- Management of shoulder subluxation should vary depending on the stage of recovery, with different approaches to handling, support, and intervention required for flaccid and spastic presentations 6